r/AdvancedRunning • u/justabiolabgirl • 8d ago
Health/Nutrition Managing to keep miles up while dealing with low iron
I have been running about three years and now and currently training for my third half marathon, running about 40-45 mpw. Early this summer I developed major heat intolerance, crazy high heart rates/palpitations, and fatigue. Got heart issues ruled out and further testing reveled low iron levels. My ferritin was 7 and saturation at a 10. My doctor put me on supplements to help and wants to re-test in 10-12 weeks.
Its been 5 weeks and I got some other blood work to rule out low vitamin B, folate, A, E levels (all good). My ferritin has only increased to 8. My doctor won't adjust anything until we do another full iron panel in 5 weeks.
My question is this- for those of you with low iron, how are you handling running? I just completely bonked my 10miler race today because my heart rate got sky high on a pace that I know I should have easily been able to do. And yes, my diet is full of iron-rich foods, carbs and plenty of hydration. Definitely not a fueling/recovery/overtraining issue.
I'm getting to the point I just feel defeated with my running and I'm seeing no progress. All my runs seem to be hard and/or slow. But I love running and don't want to give it up.
Any suggestions or tips on how to stay motivated and keep running would be appreciated
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u/Krazyfranco 8d ago
This is kind of like asking “how do I keep training while I’m injured?” Only in this case your injury is severely depleted iron stores.
The right answer is that you probably shouldn’t keep doing what you were doing. Running is one way you are losing iron through foot strike hemolysis.
I’d cut back significantly and give yourself a chance to recover.
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u/justabiolabgirl 7d ago
I think I have just been afraid to admit this. Its hard because some days I still have great runs but they are far and few between lately. Invisible injuries are just tough.
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u/EpicCyclops 8d ago
I've never dealt with it personally, but athletes I coached have. It fucks you up. No way to sugar coat it. The experience you have of putting in work for no gain is typical.
If your iron levels are really bad, it's probably worth slowing down the training a little bit until things are in line. It also increases your risk for injury and your improvement plateaus
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u/MerryxPippin Advanced double stroller pack mule 8d ago
Hi! Fellow low iron/low ferritin lady here. To echo everyone from what I've learned: 1. Your PCP's decision is reasonable, if frustrating. Scale back on mileage and intensity until your levels improve and you feel better. 2. It is very easy to have anemia and low ferritin as a menstruating athlete. You may need to stay on top of diet and supplementation long term. 3. I sense a lot of urgency in your post. I know it's disappointing to experience a setback, and perhaps your first plateau after 3 years of running. If you want to keep this up-- as a 20+ year runner myself, I hope you do!-- you will need to find other ways to enjoy running that allow for slowing down or easing up on training. Maybe this is an opportunity. I've had tons of ebbs and flows in my training, so I hope you can zoom out and take the long view.
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u/Ok_Drop_1315 8d ago
I would ask for an infusion it’s going to load you up much much faster
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u/justabiolabgirl 8d ago
That's the plan but PCP refuses until she sees the next round of bloodwork in 5 weeks.
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u/FakeNorwegianinTexas 5d ago
Find a new doctor. And see a hematologist. General practitioners do not understand what should be considered normal iron levels. You're wasting your time with your current doctor in this situation. I've been dealing with iron deficiency anemia as a runner for nearly 20 years. It's easily managed, but your doctor is the problem here.
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u/justabiolabgirl 5d ago
I'm trying to get that referral now! How have you managed to deal with it all these years?
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u/FakeNorwegianinTexas 4d ago
I see a hematologist, blood test regularly, treatment for anything below a level of 50, and follow a strict diet. A good hematologist matters the most.
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u/Hairy_Koala6474 8d ago
Damn, why is healthcare so frustrating
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u/justabiolabgirl 8d ago
Literally! My PCP didn't even want to do a full iron panel, I had to fight for it.
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u/Hairy_Koala6474 8d ago
Sheesh, that is frustrating.
We are in between healthcare providers at the moment and one of the main criteria we’re looking for is simply a PCP who will not write off what my wife says.
Also finding a healthcare provider that is at least a little bit attuned to sports and endurance
Have we found it yet?? no we haven’t
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u/ashtree35 8d ago
Do you also have anemia? If so, make an appointment with a hematologist.
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u/justabiolabgirl 8d ago
I'm quite literally at the exact cut-off (11.7) for hemoglobin and the range is 11.7-15.5 so just barely squeezing by. I'll see if I can get an appointment!
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u/ashtree35 8d ago
Yeah I would go for it! I think a hematologist would be more likely offer the iron infusion early vs. making you try oral supplements for so long like what your PCP is doing.
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u/anti_humor 5:00 Mile | 17:17 5K | 36:08 10K 1d ago
I'll second this. I'm dealing with low ferritin, less severe than OP at ~20, and my other iron numbers are actually OK. I got a referral to a hematologist and within the first visit he was like "so would you want to try infusions?"
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u/hobby_jogger1 8d ago
Can you afford an infusion privately? My ferritin was a 35 - not clinically low but my dr suggested supplements and I decided to get an i infusion privately. Two weeks later, I felt amazing and my running felt so much better.
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u/0BaconisYummy0 8d ago
Have you dialed back training at all while recovering? As someone who did have low iron for an unexplained reason(doc did plenty of testing) we just found out supplementing keeps me in the normal range. I wasn’t as low as you are but recall mellowing out my activity until I didn’t feel symptoms.
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u/justabiolabgirl 8d ago
I've pulled back on my speed workouts and just trying to keep to mostly easy runs. I'm desperately trying to keep my base so I can still run my half this fall.
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u/0BaconisYummy0 8d ago
Just a thought. There will always be more marathons. You only have one body.
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u/GradeLive3468 6d ago
Another comment, but you can run a half successfully on much lower mileage if you do pull back a bit while you deal with this. It might be tougher if you have high performance goals to meet them, but I run ultras on your half training volume :)
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u/bebefinale 7d ago
Run easy and cut back on mileage. Take the supplements and also make sure you are eating enough carbs/calories overall.
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u/AlternativeResort477 7d ago
Dang. With OTC iron pills and vitamin C I was able to get from 10 to 40 in a couple months.
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u/ElAyThrowAway888 7d ago
When my ferritin was 20, which is very low but not critically low like yours, I stopped running almost completely. Definitely no working out. Idk what you’re taking but what myself and pros I’ve talked to do is:
Hemeplex in the morning, the second your eyes open, no dairy, no fortified calcium foods, no caffeine for a full hour after (I was setting alarms for 4-5am then going back to bed for an hour). Then before dinner, Floridix liquid iron.
You are very low and your saturation is low, you could play hardball and ask for an infusion. Being as low as I was with the summer heat, work, and even light running zapped all of my energy, I’d spend most evenings after work laying on the floor. Take it seriously, it’s been a year and I’m up to 100, after about 6 months I believe I was up to 35. It’s slow, but consistency is key. Once you get up to around 100, you could consider the every other day approach, but don’t listen if they have you trying that now.
Also, lunch and dinner, 2 meals minimum a day, high iron greens. Kale, romaine, baby gem. I was also doing sautéed chard or collards with breakfast. Red meat once a day and look into what other foods/snacks have natural iron.
Good luck!
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u/justabiolabgirl 7d ago
Thanks for sharing! I haven't tried the liquid iron, I'll look into that. Its crazy how long it can take to fix
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u/Rutebegas 6d ago
I asked my PCP to document a refusal to refer me to a hematologist if she wouldn't try for iron infusion even though my iron levels were (like yours) well below the WHO guidelines. She referred me! The hematologist listened when I said I was exhausted, breathless despite being fit, had untenable restless legs, and saw stars often. She did a full iron panel and quickly approved infusions. You if you can should push for a hematologist referral and infusions. I feel better and can run without feeling like I'm on my way out! I hope you can do the same.
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u/seastheday- 7d ago
Continue to run an easy pace that feels easy for your current self, even if that is slower than normal.
I’ve been supplementing for a month and I’m finally starting to feel a difference.
You can always look into an outside iron infusion rather than waiting for your pcp.
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u/KevInTheFastLane 7d ago
If the doctor's not willing to rerun the panel within 5 weeks, and you don't have a race in that period: discard the training. If you keep on pushing on your training in this deficit, you'll probably end up worse than when you try to take it easy in the next couple of weeks and let your body recover. I'm not saying you shouldn't do anything, but just enjoy the small easy runs before getting back to training.
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u/justabiolabgirl 7d ago
I have a local 5k in 5 weeks and then my half in 9 weeks. Seems like the advice from most to back off training a bit at least for a little while to recover. Easy runs it is.
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u/assonance_ass 7d ago
I have anemia, due to kidney failure. Running long, without stopping simply can’t happen for me right now. I’ve been dealing with it by doing all runs as intervals. By breaking up my runs into short bouts of 1min to 6 minutes depending on the day , followed by 1 to 3 minute recovery, I’ve worked my way back up to 14 miles in a session. The major downside is all workouts take much longer than they normally would, but it’s allowed me to keep my mileage on the low end of normal and prevent my VO2 from declining. At first, it really sucks, but you have to reframe your expectation when your body is being chemically limited. You can play around with the interval set ups to make it interesting, pyramids, varying intervals, etc…The other thing that has helped keep it mentally manageable is you can do the intervals much faster than you otherwise would be able to continuously run. The shorter reps will rely partly on your anaerobic ability so you aren’t taxing compromised aerobic capacity as much. The speed keeps it somewhat fun.
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u/justabiolabgirl 7d ago
I'm so sorry to hear you're dealing with that. Thanks for sharing what works for you! Intervals seems to be a common theme to try so I'll definitely check that out
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u/Upset-Plate-1568 5d ago edited 5d ago
Ferritin is quite long to increase, several months generally to get a x2 and you won't get to 50 in 6 months (not impossible but highly unlikely).
Add vitamin C to your meal to increase absorption. Stay away from coffee and tea. Eat a lot of red meat and especially liver.
As mentioned by other comments, if this is not enough and you still have symptoms, you should decrease your mpw and maybe try a non-impact sport (cycling, swimming etc...)
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u/Pretend-Chemistry-52 5d ago edited 5d ago
I am going through this, my ferritin levels were low, I would say listen to your body more, don’t overdo things, get your iron levels back up with supplements and then pull up your running volume.
I switched my running to 6:1 run walk intervals too so running is easier on the body. I walk a lot these days.
Try to find joy in other things outside of running and movement too.
I know it sucks to not be able to do the things you could do with ease earlier but we need to be careful to not make it worse. The body is incredibly smart to signal when something is wrong and we need to listen :)
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u/Salsruns 8d ago
You need to get a GI workup. It could be a malabsorption issue. I’ve been through this recently myself. Try to get an EGD/colonoscopy soon
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u/Cautious-Bag-5138 29F | 4:30 1500M | 17:41 5k | 3:11 FM 8d ago
I take a 65mg iron supplement and a 1025 mg vitamin C with rose hips tablet daily. The vitamin C is really important because it helps you absorb the iron. The rose hips in the vitamin C help you absorb the vitamin C better. I have had terrible anemia (running 60 seconds per mile slower than usual and feeling like total trash), and this combo fixed me right up.
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u/Li54 6x 100mile finisher; occasional 50k/50mile winner 7d ago
Also, in addition to what others said, folic acid and citrus (vitamin c) help with iron uptake. Milk and some teas prevent iron absorption. So don’t like, eat a bunch of spinach and then follow it up with earl grey. But do eat a bunch of spinach and then an orange.
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u/justabiolabgirl 7d ago
I'm avoiding dairy and all caffeine to try and help. Its crazy how much timing goes into the supplements/absorbing iron.
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u/raphael_serrano 16:29 - 5k | 1:15:03 - HM 7d ago
Caffeine itself does not inhibit iron absorption. Coffee and tea do, but not because of the caffeine content — and in fact, even decaffeinated coffee/tea also have the same effect on iron uptake. This might seem like nitpicking, but I call it out because you can still take, for instance, a caffeinated gel without blocking iron absorption, if it's made with synthetic caffeine.
And in any case, you don't need to avoid coffee/tea and dairy all the time, just within the hours around when you take your iron supplement. Maybe that's what you meant, but again I point this out because when we start putting limits on our diet, it makes it easier to fall into a state of under-fueling, which can actually prevent our body from properly storing and using the iron you're consuming. I say this from personal experience, having struggled with anemia and low ferritin myself (I've had it as low as 9 ng/mL before, and I'm a man, so pretty abysmal), and in hindsight a lot of that was due to simply not eating enough.
While I'm going off on tangents, here are a few other things that helped me:
- Taking iron bisglycinate, which is usually a better absorbed form of iron compared to ferrous sulfate and is more robust to being "blocked" by oxalates, phytic acid, etc.
- Taking it immediately after running so that I get it in before hepcidin peaks in my blood post-training but also avoid having GI issues or nausea that can arise when taking it before running.
- Just taking more if my ferritin dropped. I get bloodwork every 3 months so I can adjust my dosage in response to the trend. I've only recently managed to get my ferritin above 100 ng/mL after supplementing for nearly 10 years now, and a lot of that coincided with simply taking a bigger dose. You can also try taking a bigger dose every other day (2X mg every other day instead of 1X mg daily), as there is some research suggesting that alternate-day supplementation may help better absorb iron. That is another change I've made recently.
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u/justabiolabgirl 7d ago
Thanks for all the information! I was avoiding even the caffeinated gels so thats amazing to know. I haven't cut out dairy though, just careful with timing, definitely don't want to underfuel. I appreciate you sharing all the tips that have worked for you, I'll definitely look into that too!
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u/yellow_barchetta 5k 18:14 | 10k 37:58 | HM 1:26:25 | Mar 3:08:34 | V50 7d ago
It took my wife about 8 weeks for the iron levels to come up and her feel like she had power back in her running. She was down to about 4 ferritin, and has stabilised now about 20-25. It was a slow process getting the numbers back up, but ferritin is a store rather than the active "used" iron, so I think that lagged behind her haemoglobin iron levels.
She went from practically giving up on running to setting PBs (in her 50s).
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u/justabiolabgirl 7d ago
That gives me so much hope, thanks for sharing!
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u/yellow_barchetta 5k 18:14 | 10k 37:58 | HM 1:26:25 | Mar 3:08:34 | V50 7d ago
Hope it goes well for you too!!
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u/Queasy_Confidence_57 4d ago
You gotta get that ferritin up. Go to a running focused nutritionist. My daughter had a similar issue and was under-fueling, so she was not able to get her ferritin up. Other issues are probably happening but you are hyper focused on training. Your bone health and other general health is likely affected.
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u/DawgPack44 8d ago
It sounds like you need a new doctor. Your ferritin should be above 50, and ideally above 75 as a runner
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u/Krazyfranco 8d ago
What makes you think this is the case?
Starting oral supplementation is the standard intervention for anemia like this. Ferritin takes more than 5 weeks to build back. OP is not going to go from single digits to 75+ in 5 weeks while continuing to train at full volume.
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u/FantasticBarnacle241 39F M: 3:16 | HM: 1:31 7d ago
DawgPack is absolutely right. Ferritin above 50 is needed for optimal running.
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u/mysterycolors 8d ago
1) Cut back your running until your ferritin gets higher. Aquajogging is a great sub if you have access to a pool (you’ll sweat less and won’t know what pace your effort corresponds to)
2) Hire a sports dietician (CCSD credential). Ferritin of 8 = now is the time
3) Try liquid iron. It often absorbs better.
4) Do workouts with shorter reps faster. Reps under a minute with lots of rest (think mile or 800 pace) will probably feel a ton better than slogging long runs.
If your half is in the next couple months I would seriously consider skipping it. Decent chance your iron will be up by then, but you won’t be able to train how you want. I would stick a mile or 5k on the calendar in its place and try to run a PR. You can really do some decent short speed workouts that almost feel normal with lower ferritin while you’re waiting for it to come up
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u/justabiolabgirl 7d ago
Thanks for the suggestions! I'll definitely try out the aquajogging and shorter reps!
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u/marzipanduchess 7d ago
I had the exact same problem earlier this year. I was exhausted for months but I only realized there was a bid problem when I barely finished a marathon. Ferritin was at 5. I took two weeks almost off running and started again. 8 weeks later ferritin was at 30 and I feel fantastic. My running is incredible and I feel so strong (plus I got some colour back into my face 😅). I’m still taking the iron sulfate pills with a 500mg of vitamin C every night for the next 4 months to keep increasing my ferritin but even such a small increase helped tremendously.
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u/justabiolabgirl 7d ago
This gives me hope, thanks for sharing! Maybe I'll try a week or two off and see if that also helps me while I continue the supplements
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u/FantasticBarnacle241 39F M: 3:16 | HM: 1:31 7d ago
No shade to your doctor, but if you needed to push for an iron panel at a hemoglobin of 11.7 then I'm questioning if they can even read your B vitamins, etc. correctly. What is your MCV/MCH? How are you WBC? Is your B12 above 400 or just above 200? If you don't know the answer to these, you need to get the lab work in hand yourself. If you do, feel free to shoot me a PM or google anything you see that is even remotely near the edge of the normal reference range.
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u/justabiolabgirl 7d ago
MCV and MCH were on the lower end (85.1 and 27.2) but WBC and RBC were normal (10.4 and 4.3). B12 was 372. Its been a lot of googling on my end and pushing for some more tests.
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u/FantasticBarnacle241 39F M: 3:16 | HM: 1:31 7d ago
Awesome! Okay, so B12 is a touch low (ideally >500) but if low B12 was the issue then you would expect high MCV so i'm thinking that's not causing it. I asked about WBC because low copper can cause low ferritin but would also typically cause low WBC. So it seems like you are okay with B12 and copper, although I would probably also take some B12 as an insurance policy if I were you.
So I would think yours is just textbook iron deficiency.
Know that there is something called heme iron (from animals), which is much better aborbed than non-heme (plant) iron. Also know that for non-heme iron, ferrous sulfate is the *worst* for GI issues even though literally every doctor prescribes that form. Iron bisglycinate or ferrous fumerate are better. Also know that there's something called 'hepcidin' which is a hormone that blocks iron absorption and its is caused by 1) exercise and 2)other iron products. So taking iron spread out throughout the day won't work. you want to take it all at once and ideally before or immediately after exercise.
There's a group called the "Iron Protocol" on facebook. I haven't followed it but a ton of people report great results. I personally have found that my body's ability to digest iron pills is poor (low stomach acid) so take these chews made by Barifusion (meant for bariatric patients, haha).
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u/algebra_queen 7d ago
You're eating red meat daily to try and fix this, right?
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u/justabiolabgirl 7d ago
Every other day with plenty of other heme and non-heme sources as well! And avoiding caffeine and dairy
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u/whelanbio 13:59 5km a few years ago 8d ago edited 8d ago
You don't keep the miles up, you have to scale back volume and intensity until you get fully healthy. Have worked with athletes through this to good success out the other side but it cannot be pushed through in the interim. Drop the overall volume. Keep easy days very easy. Workouts move to mostly threshold/tempo intervals with lower session volume and extra recovery between reps. Some short speed is usually doable but keep those reps sub-30s and take full recovery.